Mortality and other adverse outcomes in patients with type 2 diabetes mellitus admitted for COVID-19 in association with glucose-lowering drugs: a nationwide cohort study.

BACKGROUND: Limited evidence exists on the role of glucose-lowering drugs in patients with COVID-19. Our main objective was to examine the association between in-hospital death and each routine at-home glucose-lowering drug both individually and in combination with metformin in patients with type 2 diabetes mellitus admitted for COVID-19. We also evaluated their association with the composite outcome of the need for ICU admission, invasive and non-invasive mechanical ventilation, or in-hospital death as well as on the development of in-hospital complications and a long-time hospital stay. METHODS: We selected all patients with type 2 diabetes mellitus in the Spanish Society of Internal Medicine's registry of COVID-19 patients (SEMI-COVID-19 Registry). It is an ongoing, observational, multicenter, nationwide cohort of patients admitted for COVID-19 in Spain from March 1, 2020. Each glucose-lowering drug user was matched with a user of other glucose-lowering drugs in a 1:1 manner by propensity scores. In order to assess the adequacy of propensity score matching, we used the standardized mean difference found in patient characteristics after matching. There was considered to be a significant imbalance in the group if a standardized mean difference > 10% was found. To evaluate the association between treatment and study outcomes, both conditional logit and mixed effect logistic regressions were used when the sample size was ≥ 100. RESULTS: A total of 2666 patients were found in the SEMI-COVID-19 Registry, 1297 on glucose-lowering drugs in monotherapy and 465 in combination with metformin. After propensity matching, 249 patients on metformin, 105 on dipeptidyl peptidase-4 inhibitors, 129 on insulin, 127 on metformin/dipeptidyl peptidase-4 inhibitors, 34 on metformin/sodium-glucose cotransporter 2 inhibitor, and 67 on metformin/insulin were selected. No at-home glucose-lowering drugs showed a significant association with in-hospital death; the composite outcome of the need of intensive care unit admission, mechanical ventilation, or in-hospital death; in-hospital complications; or long-time hospital stays. CONCLUSIONS: In patients with type 2 diabetes mellitus admitted for COVID-19, at-home glucose-lowering drugs showed no significant association with mortality and adverse outcomes. Given the close relationship between diabetes and COVID-19 and the limited evidence on the role of glucose-lowering drugs, prospective studies are needed.

Pérdidas de seguimiento de personas con infección por el VIH en la cohorte española VACH en el periodo 2013-2014: importancia de los factores sociodemográficos / Losses to follow-up of HIV-infected people in the Spanish VACH cohort over the period between 2013 and 2014: The importance of sociodemographic factors

OBJETIVO: Determinar la proporción de personas con infección por VIH o sida que se encontraban en seguimiento en la cohorte VACH en 2012 y que resultaron perdidas del mismo en 2013 y 2014, así como establecer las características sociodemográficas relacionadas con dicha pérdida. MÉTODOS: Consideramos perdidos del seguimiento a los sujetos con menos de un registro de consulta por año analizado. Construimos modelos de regresión logística para la estimación de las razones de ventajas (odds ratio [OR]) y sus intervalos de confianza del 95% (IC del 95%) de las variables relacionadas con la pérdida de seguimiento. RESULTADOS: El porcentaje global de pérdidas en seguimiento fue del 15,5% (IC del 95%: 14,9-16,1). Las variables asociadas con la pérdida de seguimiento fueron no recibir tratamiento antirretroviral (TAR) (OR: 1,948; IC del 95: 1,651-2,298), ser inmigrante (OR: 1,746; IC del 95: 1,494-2,040), el consumo de fármacos por vía intravenosa como mecanismo de transmisión del VIH (OR: 1,498; IC del 95: 1,312-1,711), encontrarse en situación de desempleo (OR: 1,331; IC del 95: 1,179-1,503), no tener pareja (OR: 1,948, IC del 95: 1,651-1,298), pertenecer a un estrato socioeconómico bajo (OR: 1,279; IC del 95: 1,143-1,431) y ser atendido en un hospital con menos de 1.000 pacientes en seguimiento (OR: 1,257; IC del 95%: 1,121-1,457), además de menor edad y menos tiempo de seguimiento en la cohorte. CONCLUSIONES: El 15,5% de los pacientes fueron perdidos del seguimiento en un periodo de 2años en la cohorte VACH. Ello se asoció a una serie de variables sociodemográficas y epidemiológicas, cuya identificación puee ser útil para diseñar iniciativas focalizadas sobre las poblaciones más susceptibles de abandonar los circuitos asistenciales y a orientar estrategias diseñadas a la consecución del objetivo 90-90-90

OBJECTIVE: To determine the proportion of people infected by HIV or AIDS under follow-up in the VACH Cohort in 2012 who were lost to follow-up from 2013 to 2014, and to establish the sociodemographic features relating to this loss. METHODS: We considered subjects with less than one recorded consultation per year studied to be lost to follow-up. We built logistic regression models to calculate the odds ratios (OR) and their 95% confidence intervals (95% CI), of the variables relating to loss to follow-up. RESULTS: The overall percentage of losses to follow-up was 15.5% (95% CI 14.9-16-1). The variables associated with loss to follow up were: not receiving antiretroviral treatment (ART) (OR: 1.948, 95% CI: 1.651 -2.298), being an immigrant (OR: 1.746; 95%CI: 1.494-2.040), intravenous drug consumption being the mechanism for HIV transmission (OR: 1.498, 95% CI: 1.312-1.711), being unemployed (OR: 1.331; 95% CI: 1.179-1.503), being without a partner (OR: 1.948, 95% CI: 1.651-1.298), belonging to a low socioeconomic class (OR: 1.279; 95% CI: 1.143-1.431), and being attended in a hospital with fewer than 1000 patients under follow-up (OR: 1.257, 95% CI: 1.121-1.457), as well as being under age and having spent less time under follow-up in the Cohort. CONCLUSIONS: 15.5% of the patients were lost to follow-up over a period of 2 years in the VACH Cohort. This was associated with a series of sociodemographic and epidemiological variables that it might be useful to identify to design initiatives targeting the populations most likely to abandon the circuits of care, and guide strategies towards achieving Objective 90-90-90

Losses to follow-up of HIV-infected people in the Spanish VACH cohort over the period between 2013 and 2014: The importance of sociodemographic factors. / Pérdidas de seguimiento de personas con infección por el VIH en la cohorte española VACH en el periodo 2013-2014: importancia de los factores sociodemográficos.

OBJECTIVE: To determine the proportion of people infected by HIV or AIDS under follow-up in the VACH Cohort in 2012 who were lost to follow-up from 2013 to 2014, and to establish the sociodemographic features relating to this loss. METHODS: We considered subjects with less than one recorded consultation per year studied to be lost to follow-up. We built logistic regression models to calculate the odds ratios (OR) and their 95% confidence intervals (95% CI), of the variables relating to loss to follow-up. RESULTS: The overall percentage of losses to follow-up was 15.5% (95% CI 14.9-16-1). The variables associated with loss to follow up were: not receiving antiretroviral treatment (ART) (OR: 1.948, 95% CI: 1.651 -2.298), being an immigrant (OR: 1.746; 95%CI: 1.494-2.040), intravenous drug consumption being the mechanism for HIV transmission (OR: 1.498, 95% CI: 1.312-1.711), being unemployed (OR: 1.331; 95% CI: 1.179-1.503), being without a partner (OR: 1.948, 95% CI: 1.651-1.298), belonging to a low socioeconomic class (OR: 1.279; 95% CI: 1.143-1.431), and being attended in a hospital with fewer than 1000 patients under follow-up (OR: 1.257, 95% CI: 1.121-1.457), as well as being under age and having spent less time under follow-up in the Cohort. CONCLUSIONS: 15.5% of the patients were lost to follow-up over a period of 2years in the VACH Cohort. This was associated with a series of sociodemographic and epidemiological variables that it might be useful to identify to design initiatives targeting the populations most likely to abandon the circuits of care, and guide strategies towards achieving Objective 90-90-90.

Effect of ethnicity on clinical presentation and risk of antiphospholipid syndrome in Roma and Caucasian patients with systemic lupus erythematosus: a multicenter cross-sectional study.

AIM: To determine if there are ethnic differences in the prevalence of antiphospholipid syndrome (APS), clinical presentation and autoantibody profile between Roma and Caucasian patients with systemic lupus erythematosus (SLE). METHOD: A cross-sectional study was conducted including data from Roma and Caucasian SLE patients consecutively attending six hospitals in Spain. Socio-demographic characteristics, prevalence of APS, clinical and analytical features of SLE and APS were compared between ethnic groups. RESULTS: Data from 52 Roma and 98 Caucasian SLE patients were included. Roma SLE patients had a higher risk (odds ratio 2.56, 95% CI 1.02-6.39) and prevalence of APS (28.8% vs. 13.3%, P = 0.027). Furthermore, Roma SLE patients had a statistically significant higher prevalence of abortions (23.5% vs. 10.2%, P = 0.049). In relation to other APS diagnostic criteria, Roma SLE patients had a non-statistically significant higher prevalence of fetal deaths (14.3% vs. 5.1%, P = 0.106) and thrombotic events (21.1% vs. 12.2%, P = 0.160). In relation to SLE clinical features, Roma patients had a significantly higher prevalence of arthritis (75% vs. 57.1%, P = 0.034) and non-significant higher prevalence of serositis (44.2% vs. 29.6%, P = 0.104), discoid lesions (11.5% vs. 5.1%, P = 0.191), oral ulcers (46.1% vs. 34.7%, P = 0.218) and livedo reticularis (21.1% vs. 15.3%, P = 0.374). No statistically significant differences were found in the Systemic Lupus International Collaborating Clinics Damage Index or the autoimmune serological profile. CONCLUSION: Prevalence and risk of APS were significantly higher in Roma SLE patients. Furthermore, Roma patients had a significantly higher prevalence of abortions and a non-significant higher prevalence of fetal deaths and thrombotic events.

Alcohol and psychotropic substance use in female spanish victims of intimate partnet violence / Consumo de alcohol y sustancias psicotrópicas en mujeres españolas víctimas de violencia de género en la pareja

BACKGROUND: Studies show high use of alcohol among American women who are victims of intimate partner violence (IPV), but not in Spanish victims. This study examines hazardous drinking, use of psychotropic substances, and the relationship with psychopathological symptoms in Spanish women who are victims of IPV. METHOD: 50 battered women and 50 control women from general population were assessed. RESULTS: Hazardous drinking in women victims of IPV (18.4% and 24.5%) was higher than in previous Spanish studies, and lower than in controls (no significant difference). Women victims of IPV showed a significantly higher use of psychotropic medication than controls (40% vs. 20%). For women victims of IPV, psychopathological symptoms were not related to use of alcohol, but use of psychotropic medication was related to post-traumatic arousal. CONCLUSIONS: Results suggest that Spanish women victims of IPV may resort to psychotropic medication rather than alcohol to cope with their symptoms

ANTECEDENTES: los estudios muestran un alto consumo de alcohol en las mujeres maltratadas americanas, pero no en las españolas. Este estudio examina en mujeres maltratadas españolas: el consumo de riesgo de alcohol, el consumo de sustancias psicotrópicas y la relación con los síntomas psicopatológicos. MÉTODO: 50 mujeres maltratadas y 50 mujeres controles de la población general fueron evaluadas. RESULTADOS: el consumo de riesgo de alcohol en mujeres maltratadas (18,4% y 24,5%) fue superior al encontrado en los estudios españoles previos, e inferior a los controles (sin diferencias significativas). Las mujeres maltratadas mostraban un consumo de psicofármacos significativamente mayor que las controles (40% vs. 20%). En las mujeres maltratadas, los síntomas psicopatológicos no estaban relacionados con el consumo de alcohol, sin embargo el consumo de psicofármacos se relacionaba con la activación postraumática. CONCLUSIONES: los resultados sugieren que las mujeres maltratadas españolas pueden recurrir a los psicofármacos en lugar de al alcohol para hacer frente a sus síntomas

Posttraumatic Stress Symptomatology in Pre-Hospital Emergency Care Professionals Assaulted by Patients and/or Relatives: Importance of Severity and Experience of the Aggression.

Exposure to violence from patients or relatives causes problems in emergency departments. To assess the development of posttraumatic symptoms in pre-hospital emergency care professionals assaulted by patients and/or relatives, it may be crucial to establish preventive measures at different levels. This study examined 358 pre-hospital emergency care professionals assaulted by patients and/or relatives. The aims of the present study were (a) to assess the presence of posttraumatic symptoms and posttraumatic stress disorder (PTSD) and (b) identify compliance diagnoses for PTSD depending on the experience of aggression (presence of fear, helplessness, or horror during the aggression), the perceived severity of aggression, and socio-demographic variables (gender, age, profession, employment status, and work experience). The results show that the experience of aggression with fear, helplessness, or horror is associated with the presence of posttraumatic symptoms related to re-experiencing but is not related to avoidance and emotional numbing and arousal. Furthermore, the perception of aggression as severe was associated with the presence of symptoms related to re-experiencing. These results are presented and discussed.

La evaluación de la calidad de vida en personas con demencia / Quality of life assessment in patients with dementia

La calidad de vida (CV) es una de las variables resultado más importantes para estudiar la eficacia de intervenciones en personas con demencia. Sin embargo, su evaluación es difícil porque: a) este es un constructo complejo para el que no existe una aproximación teórica o conceptual unificada, y b) porque al tratarse de personas con deterioro cognitivo se complica enormemente la obtención de información fiable. En este trabajo se revisan diferentes métodos e instrumentos dirigidos a este fin. Es importante tener en cuenta la visión subjetiva de la propia persona evaluada pues las evaluaciones de personas próximas tienden a subestimar la CV. A pesar de que el campo necesita más desarrollo, se concluye que el instrumento de elección es el QOL-AD, por ser sensible al cambio, correlacionar con medidas de salud, estar traducido a varios idiomas y poder administrarse a personas con puntuaciones bajas en el MMSE(AU)

Quality of life (QoL) is one of the most important outcome variables in the study of the efficacy of interventions with people with dementia. However, its assessment is difficult 1) because it is a complex construct for which there is no unified theoretical or conceptual approach, and 2) because of the inherent difficulties in the cognitive impairments of the people under study. In this work different methods and instruments to this end are reviewed, and related findings are discussed. It is important to take into account the subjective view of the assessed person, as assessments done by proxies tend to underestimate QoL. In spite of the need for further development in this field, it is concluded that the instrument of choice is the QOL-AD, as it is change-sensitive, it correlates with health measurements, it is translated into several languages and it can be administered to people with low MMSE scores(AU)

[Quality of life assessment in patients with dementia]. / La evaluación de la calidad de vida en personas con demencia.

Quality of life (QoL) is one of the most important outcome variables in the study of the efficacy of interventions with people with dementia. However, its assessment is difficult 1) because it is a complex construct for which there is no unified theoretical or conceptual approach, and 2) because of the inherent difficulties in the cognitive impairments of the people under study. In this work different methods and instruments to this end are reviewed, and related findings are discussed. It is important to take into account the subjective view of the assessed person, as assessments done by proxies tend to underestimate QoL. In spite of the need for further development in this field, it is concluded that the instrument of choice is the QOL-AD, as it is change-sensitive, it correlates with health measurements, it is translated into several languages and it can be administered to people with low MMSE scores.

Influencia de las posiciones de la mujer sobre distintos parámetros en el proceso del parto / Influence of the position of the parturient on different parameters associated with childbirth

La finalidad de este artículo es describir la influencia de las posiciones en el parto con respecto a diferentes parámetros de interés clínico. Se ha realizado una revisión bibliográfica sobre la posición de la mujer en los periodos de dilatación y expulsivo en el parto. Se presentan los riesgos y beneficios de cada una de las posibles posturas a adoptar por la mujer

The purpose of this article is to describe the influence of body position during the childbirth on different parameters of clinical interest. The authors have reviewed the literature regarding the position of the parturient during dilation and delivery. Here, they discuss the risks and benefits associated with each of the possible postures that can be adopted by the woman (AU)

Detection of secondary mumps vaccine failure by means of avidity testing for specific immunoglobulin G.

The aim of this study was to discriminate between primary and secondary vaccine failure in children with mumps using IgG avidity testing. Thirty-nine serum samples from children with mumps, confirmed by specific IgM, were studied. The patients were grouped according to their immunization status. The secondary immune response was defined by IgG with an avidity index >32%. A secondary response in infected children previously immunized was considered as a secondary vaccine failure. Vaccinated children presented higher IgG titers and IgG avidity than unvaccinated children. The proportion of secondary immune responses in unvaccinated patients was lower than that obtained in previously vaccinated infected patients. Avidity testing can be a useful tool to detect secondary vaccine failure in mumps.

Tratamiento farmacológico de la dependencia a la cocaína / Pharmacological treatment of cocaine addiction

El consumo de cocaína está alcanzando una trascendencia cada vez mayor en nuestro país. En el momento actual no se dispone de tratamientos farmacológicos eficaces y son los tratamientos psicosociales los más extendidos. Sin embargo, la búsqueda de fármacos que puedan mimetizar o antagonizar los efectos de la cocaína es intensa desde mediados de los años 80.Los autores presentan una revisión de la situación actual tanto en la investigación como en la clínica del tratamiento farmacológico de la cocaína. Esta se ordena según el mecanismo de acción de la molécula en cuestión, principalmente sobre receptores de dopamina, serotonina, receptores opioides, glutamatérgicos y gabaérgicos. Por último se ofrece una miscelánea donde se revisan otros posibles abordajes. Se exponen las hipótesis que justifican cada tipo de intervención (AU)